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F0919
D

Call Lights Not Accessible to Residents

Colton, California Survey Completed on 12-02-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that the call light was within reach for two residents. For one resident with chronic kidney disease and a history of repeated falls, the call light was observed wrapped around the left bed rail with the cord hanging down toward the floor, and the bedside table was placed against the left bed rail, obstructing access to the call light. The resident stated he was unaware of the location of the call light and could not recall the last time he experienced a fall in the facility. For the second resident, who had a nondisplaced bimalleolar fracture and a history of repeated falls, the call light was clipped to the top portion of the bed with the cord oriented away from the resident, making it unreachable. During interviews and observations, a CNA confirmed that both residents were unable to reach their call lights when asked. The CNA and LVN both stated that the facility policy requires call lights to be within reach. The DON and ADON reviewed photographic evidence and confirmed that the call lights were not accessible to the residents, acknowledging that this was not acceptable and that staff are responsible for ensuring call lights are within reach after providing care. The facility's policy was reviewed and specifies that call lights must be within easy reach when residents are in bed or confined to a chair.

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